DESCRIPTION: Project Summary: The 1999 Institute of Medicine (IOM) report, To Err is Human, identified the emergency department as the area of the hospital with the highest risk of adverse events. The long term goal of this work is to identify the causes of medical error as well as to decrease the numbers of and mitigate the effects of medical error through the use of multidisciplinary simulation-based teamwork training in a pediatric hospital. The goals of this project directly correspond to the areas identified as priorities for AHRQ including: identifying threats, identifying, evaluating and implementing effective patient safety practices; and maintaining vigilance. In this project, all healthcare providers (including residents) will participate in critical pediatric simulations that take place in the clinical setting during the workday. In addition to embedding teamwork training in the workplace, a critical goal of this work is the validation of simulation as a method to detect latent safety threats and system issues. Critical simulations and actual resuscitations will be digitally recorded and evaluated for teamwork behaviors and observable errors. Knowledge and attitudes of participants will be assessed on a semi-annual basis. Identification and classification of safety threats as well as actions taken to address these will also be analyzed. The specific aims of this project are: 1. To implement ongoing in situ multidisciplinary simulation training that encompasses teamwork behaviors and critical communication skills in the clinical environment; 2. To use in situ simulation training and debriefing to assess latent safety threats as well as resource and system issues in the clinical environment; 3. To evaluate the effectiveness of this training by assessing teamwork behaviors and observable errors for critical pediatric simulations; 4. To evaluate the transfer of the skills from critical simulations to the emergency department and other high risk environments through the evaluation of teamwork behaviors observed during the actual care of high risk patients. Relevance: This project uses simulation as a tool for the identification of safety threats and system issues in the clinical environment as well as providing ongoing reinforcement of teamwork training for the clinical care team. This will establish teamwork training as a routine part of clinical practice and promote frequent deliberate practice of these skills. It is unique in using simulation to learn about and impact the clinical environment. [unreadable] [unreadable] [unreadable] [unreadable] [unreadable]